ID: 219407 The Cardiac Patient and Neuromodulation, When Anticoagulation Dictates the Intervention

Introduction: Patients with cardiac comorbidities present unique challenges for undergoing interventional pain procedures. Consensus guidelines on safe anticoagulation management are categorized by procedure, patient specific bleeding risk factors, and class of anticoagulation (Table 1, Table 2).1 Specifically, some procedures occur in close proximity to the spinal cord, require large gauge needles and styletted leads, while others are in compressible locations with minimal tissue disruption. Further, pain-induced hypercoagulation increases the risk of thrombo-vascular events.1 This accentuates the importance of interdisciplinary perioperative coordination with the prescribing cardiologist. Case: A 71-year-old male with past-medical-history of CABG, bilateral femoral-popliteal bypass, atrial fibrillation on apixaban and ticagrelor, and multiple cardiac stents presented with intermittent shooting axial back pain radiating to right buttock, lateral thigh, and calf, worsened with activity. MRI demonstrated thoracic myelomalacia, multi-level lumbar disc herniation, and moderate central canal stenosis. An initial multi-model treatment approach utilizing pharmacologic agents, physical therapy, ESI's, and RFA failed to alleviate symptoms. After extensive discussion with his cardiologist, he was scheduled for a three-day SCS trial. Ticagrelor and apixaban were held throughout the 3-day trial and for 5 and 3 days prior, respectively, while ASA was maintained. Successful trial with tip placement at T6 significantly improved function and pain scores (Figure 1). Upon planned percutaneous implant, the cardiologist recommended against surgical implantation and holding anticoagulation. Alternatively, the patient underwent bilateral lumbar medial branch PNS implant with sustained improvement in lower back symptoms. However, he contracted COVID, resulting in delayed lead explanation (>60 days) without complication. Conclusion(s): Interventional pain practice advisories are well established for anticoagulation use in the perioperative period.1,2 However, there is limited high-quality research on the appropriate length to hold anticoagulation prior to surgery for high thrombotic risk patients. Collegial decision making with the cardiologist was required to avoid deleterious procedural complications. However, they may be unfamiliar with the nuances between interventions or between trial and implant. Prospective studies have shown that low risk procedures, such as the PNS, may not require holding anticoagulants.3 Other case data has demonstrated post-SCS epidural hematoma with ASA use after being held for 1-week prior to surgery. Our patient was unable to undergo SCS implant and instead elected for a lower risk procedure with excellent efficacy. 4 However, delayed PNS lead extraction due to COVID19 hospitalization presented further risk of infection and lead fracture.5 PNS may prove to be an appropriate treatment option for patients who are anticoagulated and are not SCS candidates. Disclosure: Elliot Klein, MD,MPH: None, Clarence Kong, MD: None, Shawn Sidharthan, MD: None, Peter Lascarides, DO: None, Yili Huang, DO: NoneCopyright © 2023

ID: 206479 An Evaluation of Psychological Wellbeing in Neuromodulation Patients During a Global Pandemic

Introduction: Bart's Neuromodulation Centre is a center of excellence for research and innovation. In the UK, the NICE 159 guidelines have highlighted the importance of psychological and multidisciplinary assessment to ascertain the suitability of patients for Neuromodulation. The global pandemic of Covid-19 has had far-reaching physical, psychological, and socioeconomic implications. Despite the various limitations of running services during a pandemic, Barts Neuromodulation Centre maintained the importance of multidisciplinary assessment in the selection of patients suitable for this form of therapy. This paper presents psychological wellbeing outcomes of neuromodulation patients during this unprecedented period. Method(s): Data collection was gathered remotely between January 2021 to December 2021.N=178 completed questionnaires. The mean age was 55 years and 63% were female. Data was collected at baseline and in addition, post-implant data was obtained at 1,3,6 and 12 month follow up. As per NHS England outpatient guidance (2020), all data was completed remotely. All collected data was anonymized and data was stored on an encrypted database. Result(s): Results showed a 78% decrease in depression scores from baseline to 2 years+ and a 76% decrease in anxiety scores from baseline to 2 years+. Conclusion(s): The data demonstrates significant improvements in psychological wellbeing as shown in depression and anxiety scores after SCS therapy. Despite the global pandemic, there remains a strong demand for SCS and encouragingly showed significant improvements in psychological wellbeing. It would be useful to explore ways to improve patient compliance and explore broader parameters of outcomes. Disclosure: Angie Alamgir, PHD: None, Serge Nikolic, MD: None, Habib Ellamushi: None, Amin Elyas, FRCS: None, Joanne Lascelles, Clinical nurse specialist: None, Kavita Poply, PHD: None, Sanskriti Sharma: None, Alia Ahmad, MSc: None, Vivek Mehta: NoneCopyright © 2023

ID: 218293 Real World Outcome Data in Pandemic: A Tertiary Care Neuromodulation Centre UK- 12 Months Data

Introduction: Covid-19 was classed as a global pandemic by the World Health Organization (WHO) in March 2020. This had an overwhelming effect on the National Health Services (NHS) in the United Kingdom resulting in the disruption and subsequent prioritization of the elective recovery services. Despite the various limitations of delivering services during a pandemic, Barts Neuromodulation Centre maintained the importance of multidisciplinary assessment in the selection of patients suitable for this form of therapy. We present the data on our continued activity through pandemic, dependent on the performance feasibility. The aim of this effectiveness project was to evaluate the post SCS outcome data during covid-19 pandemic. Method(s): This was a telephone and in person data collection of patient responses to standardized and validated pain outcome questionnaires following SCS implant performed at St Bartholomew's Hospital, London during January-December 2021. Data was collated from a tertiary Neuromodulation center at Barts Health NHS Trust, UK. Patients completed the questionnaires prior to SCS implant and post implant 1, 3, 6, and 12 month follow- up appointments with our neuromodulation specialists Results: Two hundred and fifteen patients underwent face to face or telephonic consultation during January to December 2021 for the follow ups. Total 178 patients registered their responses with F:M being 63%:37% and the average age 55 years. At each time point, the following number of patients completed: baseline n= 52;1 month n= 27;3 months n=28;6-month n= 21 and 12 months, n= 26. We demonstrate that NRS pain scores reduced by 43%, ODI disability improved by 35%, HADS anxiety reduced by 45%, depression reduced by 46%, PSQ sleep improved by 77% and EQ5D quality of life improved by 66% at 12 months when compared to baseline. There were no serious adverse events reported through this time. Conclusion(s): To our knowledge, this is one of the first reported real-world post SCS outcome data of prospective follow ups. We demonstrate safe delivery of services and data collection feasibility through pandemic. Moreover, our patient cohort showed improvement in the all dimensions of chronic refractory pain following SCS therapy despite clinical burden of COVID-19. Disclosure: Alia Ahmad: None, Angie Alamgir, PHD: None, Sanskriti Sharma: None, Joanne Lascelles, Clinical nurse specialist: None, Amin Elyas, FRCS: None, Helen Bonar: None, Serge Nikolic, MD: None, Habib Ellamushi: None, Vivek Mehta: None, Kavita Poply, PHD: NoneCopyright © 2023

Comparative evaluation using PRO of an algorithm of one-stage immediate alloplastic breast reconstruction versus two-stage reconstruction.

BACKGROUND: One-stage direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique, but there are some conditions that do not allow its performance. The introduction of new surgical techniques and the recent COVID-19 pandemic have pushed us to introduce a breast reconstruction algorithm in our clinical practice. This allows a one-stage immediate reconstruction for all patients, regardless of their anatomical characteristics, the type of implants used, and the need for postoperative radiotherapy. METHODS: A total of 40 patients were recruited and divided into two cohorts, 20 patients underwent immediate one-stage breast reconstruction in the period between October 2019 and January 2021, and 20 patients completed the two-stage reconstructive process in the period prior to October 2019. During the follow-up at 6 months, all patients who had completed the reconstructive process filled out the Breast-Q Reconstruction Module Pre and Postoperative scales questionnaire. The outcomes of the questionnaires were compared between the two cohorts, and statistical analysis was carried out using SPSS Statistics 20 (IBM Corporation, Armonk, NY, USA). RESULTS: The analysis of patient-reported outcomes showed that patients from the one-stage group reported better outcomes in all items evaluated. We did not find statistically significant differences concerning the rate of complications and length of hospital stay between the two groups. CONCLUSIONS: The analysis of the results shows that the outcomes reported by patients who completed breast reconstruction according to our algorithm are statistically better than those with the two-stage technique.

Simplified Zygomatic Implant Perforated (Zip) Flap for Rehabilitation in Low Level Maxillary Defects.

Rehabilitation in Low level maxillectomy cases has plethora of options right from local flaps to microvascular flaps. Subsequent to flap surgery, a maxillary dental rehabilitation can be demanding and a fixed or removable prosthesis is obligatory to provide them with near-normal function and aesthetics. Unlike the original ZIP flaps which were dedicated to microvascular flaps, we present here our unique experience with ZIP-Temporalis flap specifically for rehabilitation for patients of CAM (covid associated mucormycosis), its methods, advantages and limitations.

Management of autoimmune retinopathy treated with intravitreal dexamethasone implant.

PURPOSE: The purpose of this study is to evaluate clinical outcomes of autoimmune retinopathy (AIR) in the patients treated with intravitreal dexamethasone implant (IDI). METHOD: Twenty-one eyes of 11 AIR patients treated with at least 1 injection of IDI were retrospectively reviewed. Clinical outcomes before and after treatment, including best corrected visual acuity (BCVA), optic coherence tomography (OCT), fundus autofluorescence (FAF), full-field electroretinography (ff-ERG), and visual field (VF) at last visit within 6 and/or 12 months, were recorded. RESULTS: Among all the patients, 3 had cancer-associated retinopathy (CAR) and 8 had non-paraneoplastic-AIR (npAIR) with mean followed up of 8.52 ± 3.03 months (range 4-12 months). All patients achieved improved or stable BCVA within 6 and/or 12 months after the treatment. Cystoid macular edema (CME) in 2 eyes and significant retinal inflammation in 4 eyes were markedly resolved after single injection. Central retinal thickness (CFT) in all eyes without CME, ellipsoid zone (EZ) on OCT in 71.4% of eyes, ERG response in 55% of eyes, and VF in 50% of eyes were stable or improved within 6 months after treatment. At last visit within 12 months, both BCVA and CFT remained stable in the eyes treated with either single or repeated IDI; however, progression of EZ loss and damage of ERG response occurred in some patients with single IDI. CONCLUSION: Clinical outcomes, including BCVA and parameters of OCT, ERG, and VF, were stable or improved after IDI in a majority of AIR patients. Local treatment of AIR with IDI was a good option to initiate the management or an alternative for the patients' refractory to the systemic therapy but with limited side effect.

Main changes in the model of diagnosis-related groups in 2021.

The authors explain the main changes in the Russian model of diagnosis-related groups used for medical care payment from the funds of compulsory health insurance in 2021 compared to 2020. New diagnosis-related groups for payment for treatment of patients with malignancies of lymphoid and hematopoietic tissues, treatment and follow-up of patients with new coronavirus in-fection, rehabilitation after COVID-19 and cancer, surgical treatment of large and giant hernias with mesh implants are described. The authors discuss expanding the list of classification criteria for diagnosis-related groups, updating of approaches to cost weight coefficients for calculation of cost of antineoplastic treatment.Copyright © 2021, Media Sphera Publishing Group. All rights reserved.

2023 Western Medical Research Conference

The proceedings contain 549 papers. The topics discussed include: interleukin-2 kinase-mediated T-cell receptor signaling is critical in the development of type 1 diabetes by OT-1 T-cells;the effect of the COVID-19 pandemic on anxiety and depression in adolescents in the military population;dollars sense: a school-based effort to increase financial literacy in high school students;fostering the next generation of healthcare leaders in a pandemic world;walkability of San Bernardino county?s elementary schools in relation to various school characteristics;placebo-controlled trial in tanner 2-3 males with Klinefelter syndrome: effect of testosterone gel versus placebo in motor skills outcomes;my implant is expiring: a national secret shopper study of extended use of the contraceptive implant;comparing the effects of aerobic exercise and yoga on stress levels in college students;and are patients with a history of chest radiation therapy at higher risk for sternal wound problems after heart transplant?.

42nd Scientific Meeting of the German Society for Magnesium Research

The proceedings contain 23 papers. The topics discussed include: Mg and skeletal system: a link to osteoporosis and osteoarthritis;a putative impact of IL-6 on the expression of magnesiotropic genes through the activation of the JAK/STAT3 pathway;magnesium in pain therapy - historical notes and current aspects;Alzheimer's-associated variant rs708727 might be connected to dementia in Parkinson's disease;effect of magnesium citrate supplementation on the brain tissue of patients with Miyoshi dysferlinopathy measured by 31P magnetic resonance spectroscopy;clinical status of magnesium implants;Ionized magnesium: update 2022;magnesium in the treatment of selected types of muscular dystrophy;magnesium speciation analysis in blood serum;epigenetically-induced modulation of the HPA axis might improve resilience to chronic stress;magnesium status in patients with fibromyalgia syndrome;and post-covid-syndrome and transient microvascular pathology in pulse-wave-analysis - association with Mg/Ca ratio and magnesium therapy-options.

A Spectrum of Disease: Breast Implant-Associated Anaplastic Large Cell Lymphoma, Atypicals, and Other Implant Associations.

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.

Delayed hypersensitivity reaction to hyaluronic acid dermal filler following ChAdOx1-S recombinant vaccine against coronavirus: Case report

Case report Background: Delayed hypersensitivity reactions to hyaluronic acid fillers are usually self-limiting and uncommon, and spontaneous resolution is frequent. These are presumably T-lymphocyte- mediated reactions that can be caused by flu-like infections and vaccinations. A delayed hypersensitivity reaction after hyaluronic acid filler following the mRNA vaccine against coronavirus has already been described in the literature. We wish to present a case that followed the ChAdOx1-s recombinant COVID-19 vaccine produced by Oxford/ AstraZeneca. Case report: Female patient, 61 years old, submitted to filling of the nasojugal sulcus and nasolabial fold with 1 ml of cross-linked hyaluronic acid -15 mg/ml and after 5 days filling in the lips with 1 ml of cross-linked hyaluronic acid -12 mg/ml, dermatological office, under aseptic technique and using cannulas. It evolved with ecchymosis on the lips and nasolabial folds, with spontaneous resolution after about a week. Sixteen weeks after the procedure, she received the first dose of the ChAdOx1-s recombinant COVID-19 vaccine, and 11 weeks later, the second dose. After 30 days of the 2nd vaccine dose, asymptomatic nodules appeared distributed in the upper and lower portions of nasolabial folds, in melomentonian grooves, in the supralabial region, in the upper and lower lip in the right and left lateral portions and in the infralabial region in the left lateral portion, coinciding with the topographies of the populated areas. Ultrasonographic evaluation with Doppler confirmed these findings. At the time, she denied fever or previous infectious signs or symptoms. Previously, the patient had already been submitted to the filling of the nasojugal and nasolabial folds with a hyaluronic acid-based filler (1 ml), 29 months before the current procedure, without intercurrences. After the appearance of the nodules, she underwent treatment with prednisone 40mg for 15 days, with total weaning after another 15 days, in addition to the use of levoceritizine 5 mg daily for 20 days, with partial reduction in the size of the nodules. Due to aesthetic complaints on the part of the patient, an intralesional injection of hyaluronidase was scheduled, but it was not performed at the request of the patient herself, who opted for expectant management and clinical treatment. In October 2021, the patient reported that the nodules had involuted and in December 2021 she remained asymptomatic, referring to resorption of the entire filler.

Medium term survival in patients over ninety years-old undergoing pacemaker implantation

Background: According to the Italian National Statistical Institute, the 12- month probability of survival in the general population between 90 and 94 years-old is 26%. Pacemaker (PM) implantation is often an urgent and necessary intervention, but in these patients the benefit in terms of quality and duration of life is unclear. Purpose(s): To analyze characteristics, outcome and factors associated with survival in patients who had turned 90 at the time of PM implant. Method(s): All the PM implants performed in patients >=90 from 1/1/2019 to 12/31/2020 were analyzed. Clinical parameters, device characteristics and follow-up data were extrapolated from the SuitEstensa Ebit reporting system;the exitus was verified by analyzing data from the Regional Health System. Result(s): During the study interval, among the 554 patients undergoing PM implantation in our Center, 69 (12%) were >=90 years-old (mean age 92+/-2 years, 46% male;complete/advanced AV block in 76%). Twenty-six (38%) patients had history of atrial fibrillation and 19 (28%) ischemic heart disease. A cardiological co-morbidity (excluding AF) was present in 23 patients (33%). Oncological, pneumological and neurological comorbidities were present in 12 (18%), 19 (28%) and 32 (46%) respectively. Renal impairment was present in 25 patients (36%). In 47 patients (68%) there were at least 2 co-morbidities. After implantation (single-chamber in 36, dualchamber in 25 and VDD single-lead dual-chamber in 8 patients) complications occurred in 3 patients (2 pneumothorax and 1 lead dislodgment). Remote monitoring was activated in 57 patients (83%). Within August 31st 2021 (mean follow-up 288+/-193 days) 24 patients died (35%, 219+/-241 days after implant). Five patients (19% of patients implanted in 2019) died within 12 months. No patients died for device malfunction. Three patients died because of COVID-19 pneumonia. Renal dysfunction (Hazard Ratio-HR 8.05, p=0.002) and the presence of 2 or more co-morbidities (HR 6.03;p=0.015) were associated with a higher risk of death at univariate analysis;other significant variables were diabetes (HR 2.34;p=0.038), left ventricular ejection fraction (LVEF) (HR 0.70 for 5% variation;p=0.005), walking impairment (HR 2.99, p=0.006), the presence of oncological (HR 2.21;p=0.003), pneumological (HR 2.55;p=0.024) and neurological (HR 1.90, p=0.007) comorbidities. At multivariable analysis the only significant parameter associated with survival was LVEF (0.76 for 5% difference;p=0.043) Conclusion(s): At our Center, patients >=90 years-old undergo PM implantation mainly for advanced AVB. The good survival in the medium term, even better than expected in the general population, does not justify a too conservative attitude especially, but exclusively, in patients with less comorbidities.

Tele-Audiology: Current State and Future Directions.

The importance of tele-audiology has been heightened by the current COVID-19 pandemic. The present article reviews the current state of tele-audiology practice while presenting its limitations and opportunities. Specifically, this review addresses: (1) barriers to hearing healthcare, (2) tele-audiology services, and (3) tele-audiology key issues, challenges, and future directions. Accumulating evidence suggests that tele-audiology is a viable service delivery model, as remote hearing screening, diagnostic testing, intervention, and rehabilitation can each be completed reliably and effectively. The benefits of tele-audiology include improved access to care, increased follow-up rates, and reduced travel time and costs. Still, significant logistical and technical challenges remain from ensuring a secure and robust internet connection to controlling ambient noise and meeting all state and federal licensure and reimbursement regulations. Future research and development, especially advancements in artificial intelligence, will continue to increase tele-audiology acceptance, expand remote care, and ultimately improve patient satisfaction.

Assessment of mental workload and stress levels during the COVID19 outbreak among doctors catering to industrial workforce

Introduction: Health care providers are vital resources for every country. Their health and safety are crucial not only for continuous and safe patient care, but also for control of any outbreak. Mental workload is a broad multidimensional construct. It refers to a subjective experience of the costs incurred by a physician in performing patient. Mental demand, physical demand, temporal demand, effort, performance and frustration levels are the important dimensions on workload. Recognizing the degree to which we are affected and making strategies to make life better is important. Objective(s): To assess the mental workload status of doctors who are catering to mainly industrial workforce and what is its dimension which is putting a toll on them and the degree of stress they are experiencing, and to correlate between workload and stress levels. Material(s) and Method(s): A cross sectional study was carried out in ESIC Medical College and Hospital, from September 1 to December 31 ,2020. Both online and offline survey questionnaires were used to collect the data from doctors working in ESIC hospital, which was started after clearance from IEC and consent from participants. Workload was assessed using NASA task load index which contains 6 dimensions. This was assessed using a scale graded from 0 to 10 and stress levels were assessed using perceived stress scale. Result(s): A total of 104 participants responded to the survey of which 40(38.5%) were female and 64(61.5%) were male. The proportion of participants with high mental demand were 68(65.4%), physical demand 44(42.3%), effort demand 74(71.2%), frustration 40(38.5%), performance demand 8(7.7%) and temporal demand 44(42.3%). The proportion of participants with higher levels of workload were 90(86.5%), among whom, females were 37.8 % and males were 62.2 %. The perceived stress scale showed 2(1.9%) of participants were in low stress (score 0-13) And 80(76.9%) were in moderate stress (score 14-26) and 22(21.2%) were in high stress (score 27-40). Among participants with high stress levels 45.5 % were females and 54.5% were males. The calculated overall workload mean scores was 66.23+15.383 and perceived stress was 22.01+5.55 which is positively correlated and statistically significant. Conclusion(s): A considerate proportion of doctors' experience high workload and stress levels. Doctors being frontline workers are more vulnerable for mental health problems which are still underreported and is expected to be very considerate. There is a need to implant ways to decrease the stress levels of doctors and for better patient care.

Satisfaction of patients after implant-based subpectoral reconstruction with a titanized polypropylene mesh (TiLOOP Bra) compared to prepectoral reconstruction with a titanzied polypropylene pocket (TiLOOP Bra Pocket)

Introduction Patients' satisfaction after breast reconstruction can be evaluated with validated questionnaires as the Breast-Q questionnaire. The Breast-Q questionnaire includes different domains;one of them is "satisfaction with the result". Material(s) and Method(s): In the multicentre, prospective studies PRO (patient related outcome)-BRA (clinicaltrials.gov: NCT01885572) and PRO-Pocket (clinicaltrials.gov: NCT03868514), patient satisfaction was assessed using the Breast-Q questionnaire. In the PRO-Bra study, 269 patients underwent subpectoral surgery using the TiLOOP Bra polypropylene mesh (pfm medical ag, Germany). In the 'PRO-Pocket' study, 311 patients underwent prepectoral surgery using the TiLOOP Bra Pocket polypropylene mesh. For the evaluation, those patients from the PRO-Bra and PRO-Pocket studies who completed a Breast-Q questionnaire 6 and/or 12 months after surgery were included. The BreastQ score is measured from 0 to 100, with a score of 100 corresponding to 'very satisfied'. Satisfaction with the result of the breast reconstruction was evaluated. Result(s): In the PRO-Bra study, a total of 221 and 203 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. The mean age and BMI of the patients with completed Breast-Q were comparable between the two studies (PRO-Bra: 49.3 [+/-11.6] years, 22.9 kg/m2 [+/-3.5];PRO-Pocket: 47.7 [+/-11.7] years, 24.5 kg/m2 [+/-4.3]). In the PRO-Pocket study, a total of 258 and 266 patients completed a Breast-Q at 6 months and/or 12 months FU, respectively. In the PRO-Bra study the mean score of satisfaction with the result at 6 months follow-up (FU) was 74.5 (+/-19.9), in the PRO-Pocket 79.1 (+/-19.1), at 12 months FU the mean scores were 76.3 (+/-18.9) for PRO-Bra and 78.2 (+/-20.4) for PRO-Pocket. Furthermore, stratification according to age (cutoff 50 years) or BMI (cutoff 25 kg/m2) did not reveal any differences between the subgroups or the two studies (see Table). PRO-Bra PRO-Pocket mean score (+/-SD) 6 months 12 months 6 months 12 months BMI <= 25 75.1 (+/-19.7) 76.4 (+/-17.8) 77.7 (+/-19.9) 78.9 (+/-19.8) BMI > 25 72.1 (+/-20.7) 76.1 (+/-22.9) 82.1 (+/-16.9) 76.8 (+/-21.8) age <= 50 76.4 (+/-18.7) 77.0 (+/-18.9) 80.1 (+/-18.7) 78.1 (+/-19.6) age > 50 71.5 (+/-21.5) 75.3 (+/-19.0) 77.5 (+/-19.5) 78.4 (+/-21.8) Conclusion(s): Our data so far show high patient satisfaction with overall outcome of the surgery. In addition, patients' satisfaction with the result was comparable after subpectoral as well as prepectoral implant placement. This is particularly important in the PRO-Pocket study, as approximately 60% of the operations and the follow-up period took place during the COVID-19 pandemic.

Dermal Fillers and Covid - Delayed Inflammatory Reaction

Introduction: Dermal hyaluronic fillers are considered one of the most common minimally invasive procedures in aesthetic surgery. In the last three years, the human population has been significantly affected by the viral disease COVID-19, from which 559 million people have fallen ill and 6.36 million have died worldwide. A new, rare but significant side effect of the COVID-19 disease or a consequence of vaccination against COVID is a delayed inflammatory reaction in the area where dermal fillers were applied. Material(s) and Method(s): We present the case of two patients who developed a delayed inflammatory reaction in the area of the applied filler two and four months after the application of hyaluronic fillers for lip augmentation, and after recovering from COVID and receiving the vaccine against COVID. In both patients, the reaction was manifested by localized edema. Localized infection and the possibility of an allergic reaction to the preparation are excluded. Result(s): After the oral therapy was applied (antihistamines and pulse therapy with corticosteroids) within 24 hours, there was an improvement in the findings and a local regression of the inflammatory reaction. Conclusion(s): A literature review revealed several described cases of delayed inflammatory reaction after a COVID-19 infection or vaccination against COVID, and this side effect is still not often seen in clinical practice. The reaction between the hyaluronic acid filler and the SarsCoV-2 virus is believed to be immune-mediated. Since patients often initially contact the doctor who applied the filler, it is necessary to take into account information about past infection or vaccination in the anamnestic before administering the filler, and to take the delayed inflammatory reaction into account in the differential diagnosis. It is important to recognize this complication in time, to prevent more severe complications in time.

A study of clinical and electrophysiological characteristics of Infrahisian Wenckebach

Objectives: To study the clinico-electrophysiological profile of patients with Infrahisian Wenckebach (IHW) conduction. Material(s) and Method(s): Patients with a clinical diagnosis of atrioventricular (AV) block who underwent permanent pacemaker implantation (PPI) based on standard indications from July 2021-June 2022 at The Madras Medical Mission were subjected to pre-implant Electrophysiology study to document conduction pathology. Result(s): A total of 94 patients underwent PPI for AV block during the study period. EPS was performed in all but one patient (COVID pneumonia). The incidence of IHW was 9/93 (9.6%) of patients with AV block. There is no gender predisposition (M-4, F-5) and their mean age was 71.4 +/- 11.7 years. As many as half of the patients (5/9) had an underlying narrow QRS. The mean QRS duration was 130 +/- 19.3. Ischemic heart disease affected half of the patients and cardiomyopathy in 4/9 patients (mean EF 45.1 +/- 13.7%). Presentation was syncope in all, mean NYHA class was 2.1. Presentation ranged from isolated 1st-degree AV block (1/9) to tri-fascicular block (3/9). In EP study, the mean basal HV interval was 94.7 +/- 27.1 ms. IHW was noted spontaneously in 4 patients and on atrial pacing in the remaining. In the literature, a total of 11 documented cases have been reported (8 case reports). Unlike typical Wenckebach, the increment in PRI is minimal in the 2nd beat of the train. Conclusion(s): Wenckebach periodicity is classically considered an AV nodal phenomenon. IHW is scarcely reported in the literature. Distinction becomes critical as IHW is harbinger of a complete AV block. This is the largest series and the first clinic-etiological profile of IHW patients published to date.

Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Background: Telemedicine for adolescent and young adult (AYA) long-acting reversible contraception (LARC) care is understudied, as telemedicine was quickly implemented in response to the COVID-19 pandemic. We compare outcomes of AYA LARC follow-up care via telemedicine vs. in-person visits over 1 year. Method(s): This cohort (IRBP00030775) includes patients who 1) had an intrauterine device (IUD) or implant inserted between 4/1/20-3/31/21 and 2) attended an initial LARC follow-up visit (defined as the first visit within 12 weeks of insertion) at 1 of 4 US Adolescent Medicine clinics. Eligible patients were 13-26 years old with a LARC method inserted without sedation and in situ for at least 12 weeks. We compared outcomes over 1 year between AYAs attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported symptoms, menstrual management, acne management, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of menstrual management. Result(s): Our study included 194 AYAs, ages 13.9-25.7 years, who attended an initial follow-up visit. Most AYAs (86.6%) attended only 1 visit in the first 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site, age, race/ethnicity, prior pregnancy, concurrent medical/mental health diagnoses, and reason for LARC (Table 1). In-person attendees were more likely to have the IUD than telemedicine attendees (Table 1). Patient-reported symptoms over 1 year were similar between groups (Table 2). Menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing than telemedicine attendees (p =.001). However, no positive STI tests were captured in either group. Conclusion(s): Approximately 40% of AYAs attended their LARC follow-up visit via telemedicine. LARC type may have influenced modality of visit. While in-person attendees were more likely to have STI testing, there were no positive STI tests detected in either group during the study period. More research is needed to determine if the decrease in STI testing is clinically significant. Other outcomes were similar between visit modalities, suggesting telemedicine may be useful for AYA LARC care. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-1-ANY.docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-2-ANY.docxCopyright © 2023

Risk of failure in dental implant osseointegration among people with the post-covid syndrome

Dental implants are a standard of care in contemporary dental practice and are widely employed for the restoration of missing teeth. The long-term utility of an implant is largely dependent on the successful implant osseointegration and maintenance of the same over time. Bone metabolism and inflammatory mechanism are interrelated phenomena and are usually collectively termed osteoimmunology, which may affect the predictability and success of implant osseointegration. Many biochemical mediators of inflammation, especially Interleukin (IL)1, IL-6, and Tumour necrosis factor (TNF)alpha, have been documented to increase the activity of bone-resorbing cells through the Receptor Activator of Nuclear Factor Kappa-B (RANK) and Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL)systems. Some of the earlier studies with very limited data suggest that SARS-CoV2 infection may also directly affect bone resorption. Thus, it is imperative to understand the pathophysiology of osseointegration in COVID-19 patients, to enhance successful implant osseointegration and prevent peri-implant bone loss in these patients. Here, we present a summary of the connection between inflammatory pathways and bone metabolism on a molecular basis which may assume a significant bearing in situations of exaggerated host immune response as seen in COVID-19 infection.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

SAME DAY DISCHARGE VIA A DEDICATED RADIAL LOUNGE-RESULTS of 1-YEAR EXPERIENCE during the COVID-19 PANDEMIC

Background: Same day discharge (SDD) is a validated option for selected patients (pts) undergoing coronary angiography (CAG) and percutaneous coronary interventions (PCI). We analyzed how the COVID-19 pandemic influenced patients' admissions to and discharges from our SDD radial lounge. We focused on safety and complications. Method(s): In 2021, 817 pts (age 65+/-11 years, 28% female) were admitted to the lounge. CAG was performed in 729 pts, and 176 (24%) underwent ad hoc PCI. Furthermore, 88 pts were admitted for implantable device replacement procedures. Result(s): Out of 729 transradial CAGs 621 were performed by using the proximal radial approach (PRA) and 108 (15%) via the distal radial approach (DRA). Ninety % of all these procedures (n = 655) were performed from the nondominant left hand. PRA was associated with one radial artery occlusion (RAO) and longer compression time (92+/-24 min vs 75+/-26 min, p <0.05). In the PRA group 23 postprocedural local hematomas <5 cm (3%) and 17 hematomas <10 cm (2%) were observed but did not require specific treatment. DRA was associated with only 4 super-ficial hematomas <2 cm and no RAO. No other relevant complications occurred in the rest of pts. Ninety % of all pts (n = 732) were discharged home on the same day (<=6 hours after procedures) and none of them was readmitted within the next 24 hours. The remaining 10% of the patients (n = 85) were hospitalized after CAG and PCI, mostly because of severe coronary artery disease findings. Conclusion(s): During COVID-19 pandemic, CAG and PCI together with device replacement procedures in our SDD program were associated with a one-year saving of more than 700 overnight stays, minimal complications and 0,1% RAO rate. Supported by the Charles University Research program "Cooperatio-Cardiovascular Science" and by MH CZ-DRO (Faculty Hospital in Pilsen-FNPl, 00669806).